Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study

Publication

Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study

Journal Paper/Review - Jan 18, 2018

Jaja Blessing N R, Vergouwen Mervyn D I, Rinkel Gabriel J E, Spears Julian, Cusimano Michael D, Todd Michael, Le Roux Peter, Kirkpatrick Peter, Pickard John, van den Bergh Walter M, Murray Gordon, Johnston S Claiborne, Yamagata Sen, Mayer Stephan, Schweizer Tom A, Macdonald R Loch, Stienen Martin N., Suarez Jose I, Schaller Karl L, Saposnik Gustavo, Lingsma Hester F, Macdonald Erin, Thorpe Kevin E, Mamdani Muhammed, Steyerberg Ewout W, Molyneux Andrew, Manoel Airton Leonardo de Oliveira, Schatlo Bawarjan, Hänggi Daniel, Hasan David, Wong George K C, Etminan Nima, Fukuda Hitoshi, Torner James, SAHIT collaboration

Citation

Jaja B, Vergouwen M, Rinkel G, Spears J, Cusimano M, Todd M, Le Roux P, Kirkpatrick P, Pickard J, van den Bergh W, Murray G, Johnston S, Yamagata S, Mayer S, Schweizer T, Macdonald R, Stienen M, Suarez J, Schaller K, Saposnik G, Lingsma H, Macdonald E, Thorpe K, Mamdani M, Steyerberg E, Molyneux A, Manoel A, Schatlo B, Hänggi D, Hasan D, Wong G, Etminan N, Fukuda H, Torner J, SAHIT collaboration. Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study. BMJ 2018; 360:j5745.

Type

Journal Paper/Review (English)

Journal

BMJ 2018; 360

Publication Date

Jan 18, 2018

Issn Electronic

1756-1833

Pages

j5745

Brief description/objective

OBJECTIVE
To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH).

DESIGN
Cohort study with logistic regression analysis to combine predictors and treatment modality.

SETTING
Subarachnoid Haemorrhage International Trialists' (SAHIT) data repository, including randomised clinical trials, prospective observational studies, and hospital registries.

PARTICIPANTS
Researchers collaborated to pool datasets of prospective observational studies, hospital registries, and randomised clinical trials of SAH from multiple geographical regions to develop and validate clinical prediction models.

MAIN OUTCOME MEASURE
Predicted risk of mortality or functional outcome at three months according to score on the Glasgow outcome scale.

RESULTS
Clinical prediction models were developed with individual patient data from 10 936 patients and validated with data from 3355 patients after development of the model. In the validation cohort, a core model including patient age, premorbid hypertension, and neurological grade on admission to predict risk of functional outcome had good discrimination, with an area under the receiver operator characteristics curve (AUC) of 0.80 (95% confidence interval 0.78 to 0.82). When the core model was extended to a "neuroimaging model," with inclusion of clot volume, aneurysm size, and location, the AUC improved to 0.81 (0.79 to 0.84). A full model that extended the neuroimaging model by including treatment modality had AUC of 0.81 (0.79 to 0.83). Discrimination was lower for a similar set of models to predict risk of mortality (AUC for full model 0.76, 0.69 to 0.82). All models showed satisfactory calibration in the validation cohort.

CONCLUSION
The prediction models reliably estimate the outcome of patients who were managed in various settings for ruptured intracranial aneurysms that caused subarachnoid haemorrhage. The predictor items are readily derived at hospital admission. The web based SAHIT prognostic calculator (http://sahitscore.com) and the related app could be adjunctive tools to support management of patients.